Grief Death and Dying Handout

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Grief, death and dying

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<ul><li><p>Grief, Death And Dying Vivienne S. Caguioa-Cleofas, MD,FFPA </p><p> Learning Objectives </p><p>To know the definition of death, thanatology, grief, mourning and bereavement To know the different reactions to death To know the attitudes towards death life cycle To know the different types of grief To know how to deal with grief Thanatology Study of the experiences of dying and bereavement Death Definition: the absolute cessation of vital functions DYING: the process of losing these functions Dying, and the individuals awareness of it, imbues humans with values, passions, wishes and the impetus to make the most of time </p><p>Good Death: one that is free from avoidable distress and suffering for patients, families and caregivers and is reasonably consistent with clinical, cultural and ethical standards Bad Death: characterized by needless suffering, a dishonoring of patient or family wishes or values, and a sense among participants or observers that norms of decency have been offended </p><p> Reactions To Death </p><p>Timely Untimely Intentional Unintentional Subintentional Elisabeth Kubler-Ross (impending death) </p><p>Stage 1: Shock and Denial Stage 2: Anger Stage 3: Bargaining Stage 4: Depression Stage 5: Acceptance </p></li><li><p>Reactions To Death Mardi Horowitz </p><p> Outcry Denial and Intrusion Working Through Completion </p><p> Reactions To Death </p><p>Therese Randos 6 Rs Recognize the loss React Recollect and Re-experience Relinquish Readjust Reinvest </p><p> Attitudes Toward Death Across The Life Cycle </p><p>CHILDREN Jean Piaget Pre-school (&lt; 5 y.o.) - animistic </p><p>Perioperational stage a temporary absence, incomplete and reversible, like departure or sleep Separation from primary caregiver is a main fear </p><p>5 - 10 y.o. - inevitable human mortality Concrete operational thinking Death is a final reality that happens to old people not children Usually have active fantasies of violence and aggression dominated by themes of death and killing </p><p> Adolescents </p><p>Formal concrete operations Death is inevitable and final but may not accept possibility of their own death Great potential for isolation and withdrawal </p><p> Puberty </p><p>universal, inevitable, irreversible </p></li><li><p>John Bowlby Phase 1 : Protest Phase 2 : Despair Phase 3 : Detachment </p><p> Erick Erickson </p><p>Young adults - focus on missing the chance to marry Middle age - frustrated in their plans to enjoy hard earned pleasure Older age - confront increasing reality of their own mortality ; integrity vs despair </p><p> Spousal Bereavement among the most stressful of all life experiences Older adults have more favorable outcome Depressive symptoms peak within the first few months but decline significantly within a year Grief emotional &amp;/or psychological reaction to any loss, not limited to death Mourning </p><p>Process by which grief is resolved societal expression of post bereavement behavior and practices Rituals for mourning </p><p> Wake, internment Rituals for disposing the body Rituals for invocation of religious ceremonies Rituals for periodic official remembrances </p><p>Funeral prevailing display of bereavement </p></li><li><p>Bereavement State of being deprived of someone by death and being in the state of mourning </p><p> Bereavement </p><p> Stages according to Bowlby Stage 1 : early phase of acute despair (numbness and protest) Stage 2: phase of intense yearning and searching </p><p> Stage 3 : phase of disorganization and despair Stage 4: phase of reorganization </p><p>Bereavement in children </p><p>Symptoms indicating major depressive disorder exceeding usual bereavement Guilt related to issues beyond those surrounding the loved one Preoccupation with death other than thoughts of being dead </p><p>A childs grief can be influenced by his or her age, personality, developmental stage, earlier experiences with death, his or her relationship with the deceased </p><p>Younger than 2 yo loss of speech diffuse distress Younger than 5 yo eating, bowel and bladder dysfunctions, strong feelings of sadness, </p><p>fear, anxiety School aged phobic, hypochondriacal, withdrawn, psuedomature, school performance </p><p>suffers Adolescents behavioral problems, somatic symptoms erratic moods to stoicism </p><p>Symptoms indicating major depressive disorder exceeding usual bereavement Guilt about things other than actions taken or not taken by the survivor at the time of death Morbid preoccupation with worthlessness </p><p> Marked psychomotor retardation Prolonged marked functional impairment Hallucinatory experiences </p></li><li><p>Grief </p><p>Duration Cultural Dictated by society In children depends on support system loneliness </p><p> Anticipatory Grief Anniversary Reactions Normal Grief Uncomplicated Grief </p><p>identifying with the deceased taking on traits/ possessions hear fleeting, transient voice denial of certain aspects of the deceased </p><p>Pathological Grief believes he is the dead person or dying of the same disease persistent, intrusive complex auditory hallucinations dead person still alive </p><p>Normal Grief - disbelief, denial shock </p><p>Profound sadness survival guilt intact self esteem Sense of unreality withdrawal Anger and irritability </p><p> Pathological Grief Denial delayed or absent grief Depression impaired self esteem suicidal Progressive social isolation Hostility paranoid reactions </p></li><li><p>Grief mood fluctuations waves, washes over time limited </p><p> Depression mood disturbance is pervasive, unremitting hopeless </p><p>Grief </p><p>A normal albeit, intensely painful state that is responsive to support, empathy and passage of time Self-reproach common Survivor guilt </p><p>Major Depressive Disorder </p><p>Potentially a medical emergency that requires immediate intervention to forestall a complication like suicide </p><p> DIFFERENTIATING BEREAVEMENT from </p><p>MAJOR DEPRESSION DIFFERENTIATING BEREAVEMENT from </p><p>MAJOR DEPRESSION DIFFERENTIATING BEREAVEMENT from </p><p>MAJOR DEPRESSION Biology Of Grief </p><p>Acute Grief disruption of biological rhythms Impaired immune functioning decreased lymphocyte proliferation impaired functioning of natural killer cells </p></li><li><p>Biology Of Grief Acute Grief Mortality rate for widows and widowers following the death of a spouse is higher than that in the general population Widowers appear to be at risk longer than widows </p><p>Dealing With Grief Physician responses often reflect underlying attitudes toward death Death as a personal failure or threat to personal immortality medical training focuses almost entirely on the control and eradication of disease at the expense of care and comfort of the person with the disease Awareness of own attitudes toward death and dying Unconscious feeling of omnipotence and power of preventing death some go into Medicine because of own unconscious fears of death </p><p> Dealing With Grief </p><p>Compassionate care </p><p> Hallmarks of Appropriate Care visiting the patient regularly maintaining eye contact touching appropriately listening to what the patient have to say being willing to answer all questions in a respectful way </p><p> Preparing the family for the probability that a loved one will die Encourage the familys ventilation of feelings </p><p> Grief Therapy regularly scheduled sessions where grieving people are encouraged to talk about feelings of loss and about the person who has died attachment to the therapist provides temporary support until a sense of confidence about the future develops </p><p>Death and Burial Customs Ghost Protection Rituals </p><p>most are practiced to protect the living Appease the spirits thought to have caused the persons death Shutting the eyes of the dead person Covering the face of the dead Carry the dead out of the house feet first Mirrors were covered </p></li><li><p>Family photographs turned face down Cemeteries Tombstones to weigh down the dead Mazes at the entrance of ancient tombs Beating on the grave, firing of guns, funeral bells and wailing chants Bodies lie with their heads to the West and their feet to the East </p><p>Filipino Practices/Rituals The Wake or Vigil House, funeral parlor, church Usually lasts for 5-7 days or longer 24 hours Novenas, prayers, mass everyday Nearest kin sits beside the coffin </p><p> The Requiem Mass/Funeral Walk behind the funeral car Stop at the church after mass relative will make a speech Grave site House of the family Children are passed over the coffin 40 Days </p><p>Superstitious Beliefs Feed the mourners, but don't walk them to the door when they leave. Dont sweep the floor while the body is still lying in state or else other deaths in the family may follow No tears should fall on the dead or the coffin as it would make a person's journey to the afterlife difficult When someone sneezes at the wake, pinch him During the wake the dead person's relatives must not take a bath. Food from the wake should not be brought home because it's believed that the dead touches all of it After a funeral service, guests should not go directly home. This way the spirit of the dead won't follow them to their house When carrying a coffin out for burial, it should be carried head first as it prevents the soul of the dead from coming back Family members should wear black or white, colors are prohibited Weddings, birthdays, and other social activities should not be celebrated for one year The widow, children, and immediate family members are prohibited from carrying the coffin or else they will become ill and die While the casket is on its way to the cemetery or the church, relatives who preferred to stay at home should not have a glimpse of the casket or else someone in the family would die. </p><p>End of Lecture </p></li></ul>